First description of single-pass albumin dialysis combined with cytokine adsorption in fulminant liver failure and hemophagocytic syndrome resulting from generalized herpes simplex virus 1 infection.

Case presentation • Liver biopsy revealed acute liver cell necrosis due to herpes simplex virus type 1 (HSV-1) • Despite antiviral therapy liver failure progressed and patient was transferred to ICU • Rapid development of MOF with hepatic coma, severe coagulopathy, acute anuric renal failure, respiratory insufficiency and arterial hypotension • Patient was listed for highly urgent liver transplantation • Additional diagnosis of hemophagocytic lymphohistiocytosis (HLH), secondary to HSV-1-infection • Hemodialysis and extracorporeal liver support were initiated using MARS ® -therapy (6 hours 1 st day, 19 hours 2 nd day) • Increasing need for NE and excessively elevated concentrations of inflammatory markers indicated ongoing severe SIRS • Hence extracorporeal therapy was changed to CVVHD with SPAD (12 hours of treatment)